JVS-vascular insights最新文献

{"title":"A systematic review and meta-analysis of risk of stroke within 48 hours after an index symptomatic carotid event","authors":"Rodolfo Pini MD, PhD, FEBVS ,&nbsp;Gianluca Faggioli MD ,&nbsp;Marcello Lodato MD ,&nbsp;Eleonora Acquisti MD ,&nbsp;Federica Campana MD ,&nbsp;Betty Shiti MD ,&nbsp;Enrico Gallitto MD, PhD, FEBVS ,&nbsp;Paolo Spath MD, PhD ,&nbsp;Emiliano Chisci MD, PhD ,&nbsp;Mauro Gargiulo MD, PhD","doi":"10.1016/j.jvsvi.2025.100296","DOIUrl":"10.1016/j.jvsvi.2025.100296","url":null,"abstract":"<div><h3>Objective</h3><div>Carotid endarterectomy (CEA) for symptomatic carotid artery stenosis treatment is recommended within the first 2 weeks from index event. Despite this indication for treatment being well-accepted and demonstrated appropriate for the reduction of stroke recurrence, the treatment in the first 48 hours from the index event is debated in the literature, considering the high risk of complications and the reduction of stroke recurrence by modern medical therapies. The aim of the present study was to review the rate of stroke recurrence in the first 48 hours after the index event according to the type of preoperative symptoms.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis, registered on PROSPERO (CRD420250656373), was performed according to the PRISMA recommendations searching in three databases (Embase, PubMed, and Cochrane Database) studies on recurrence of stroke within 48 hours from the index event in patients with symptomatic carotid artery stenosis. Observational studies and studies evaluating the rate of recurrence event in the waiting time of CEA were considered. The rate of stroke in the first 48 hours from the index event, was evaluated by the Der Simonian-Laird weights of random effects model.</div></div><div><h3>Results</h3><div>Four studies, comprising a total of 2224 patients, were included in the meta-analysis. Three studies had a prospective, one of which was randomized and one was retrospective. Heterogeneity among studies was low. The overall stroke rate at 48 hours from the index event was 2.6% (95% confidence interval [CI], 1.5%-4.8%; <em>P</em> = .001). The risk of stroke within 48 hours varied significantly based on the type of index event: 0.6% (95% CI, 0.3%-6%), for amaurosis fugax (AF), 3.5% (95% CI, 1.3%-9.1%) for transient ischemic attack (TIA), and 1.3% (95% CI, 0.3%-6%) for stroke. Hypertension, diabetes, smoking, recent year of enrolment, and male gender were significant (<em>P</em> &lt; .05) moderators affecting stroke risk after TIA, whereas no moderators influenced outcomes after AF or stroke as the index event.</div></div><div><h3>Conclusions</h3><div>Few studies have investigated stroke recurrence within the first 48 hours after an index event. The pooled stroke rate was relatively low, particularly for patients who experienced AF (0.6%) or stroke (1.3%) as the index event, raising questions about the necessity for urgent CEA in these cases. However, for patients with TIA as the index event, the risk of stroke within the first 48 hours appears to be significant, suggesting that urgent intervention may be warranted.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100296"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of patient outcomes following endovascular vs surgical management of infrainguinal autogenous bypass stenosis","authors":"Meghan McGillivray MD ,&nbsp;Ningzhi Gu MD ,&nbsp;Mark Tatangelo PhD, MBA, BA ,&nbsp;Jason Faulds MD, MHSc, FRCSC ,&nbsp;Jonathan Misskey MD, MHPE, FRCSC","doi":"10.1016/j.jvsvi.2025.100341","DOIUrl":"10.1016/j.jvsvi.2025.100341","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to evaluate outcomes of open vs endovascular intervention for infrainguinal bypass stenosis.</div></div><div><h3>Methods</h3><div>A single-institution retrospective review of infrainguinal bypass stenosis cases from January 1, 2010, to December 31, 2020, was conducted. Data collected included index bypass operation, lesion characteristics, reintervention, and patient outcomes.</div></div><div><h3>Results</h3><div>Of the 146 patients included, 40% underwent open intervention, whereas 60% underwent endovascular intervention. There were no significant differences between the index bypasses of each cohort with respect to inflow, outflow, conduit, or primary patency. The severity of stenotic lesions in open and endovascular cohorts was &gt;70% severity on duplex ultrasound in 76% and 78% of patients, respectively (<em>P</em> = .02). Lesion location was not significantly different between cohorts with 48% proximal, 27% distal, 8% midgraft, 3% venovenostomy, and 14% multiple stenotic lesions. There was no significant difference in primary revision patency in open vs endovascular intervention (1109 vs 809 days; <em>P</em> = .09). The average number of repeat interventions was not significantly different (0.47 vs 0.58 times; <em>P</em> = .48); however, the average cumulative hospital length of stay was significantly shorter for patients who underwent endovascular intervention (8.21 vs 5.22 days; <em>P</em> = .02). During the study period, a comparable portion of patients in open and endovascular cohorts went on to have failed bypass grafts (17% vs 18%) with no significant difference in the total time to graft failure in these subgroups (860 vs 1144 days; <em>P</em> = .47). There were no significant differences in major adverse limb events (12% vs 8%; <em>P</em> = .59) or mortality (47% vs 40%; <em>P</em> = .52).</div></div><div><h3>Conclusions</h3><div>Open and endovascular interventions for infrainguinal bypass stenosis showed no significant differences in primary revision patency, graft failure rates, major adverse limb events, or mortality. Endovascular intervention was associated with shorter cumulative hospital stays for reintervention.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100341"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The business of vascular surgery","authors":"Krishna Jain MD, FACS","doi":"10.1016/j.jvsvi.2025.100303","DOIUrl":"10.1016/j.jvsvi.2025.100303","url":null,"abstract":"","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100303"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrograde tibiopedal access as an alternative procedural technique for genicular artery embolization","authors":"Nishanth Konduru,&nbsp;Anton Hnatov BS,&nbsp;Siddhartha Rao MD","doi":"10.1016/j.jvsvi.2025.100339","DOIUrl":"10.1016/j.jvsvi.2025.100339","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to assess the feasibility, safety, and technical outcomes of genicular artery embolization (GAE) performed via retrograde tibiopedal access.</div></div><div><h3>Materials and Methods</h3><div>GAE was performed in 357 patients utilizing tibiopedal access. Patient eligibility was determined through a comprehensive clinical evaluation and radiographic imaging. Embolic agents were delivered through a microcatheter to the targeted arteries by an interventional cardiologist with an additional 1 year of fellowship training in endovascular medicine and certification from the American Board of Vascular Medicine. Technical success was defined as successful embolization of at least two genicular arteries, with subsequent resolution of arterial blush. Peri and post-procedural data and complications related to the access site were assessed.</div></div><div><h3>Results</h3><div>Technical success was obtained in 96.6% of cases. Patient ages ranged from 38 to 98 years, with body mass index ranging from 18.01 to 63.23 kg/m². Across this study cohort, 3.7 ± 1.0 genicular arteries were embolized, with a mean procedure time of 51.3 ± 13.0 minutes. Procedure time was measured from initial injection of lidocaine to application of hemostatic device. Results also show 25% improvement in average procedure duration after 50 cases, suggesting a brief learning curve for GAE. Post-procedural complications occurred in 4.5% of cases (n = 16) and were associated only with minor, transient side effects.</div></div><div><h3>Conclusions</h3><div>GAE via tibiopedal access offers a viable alternative to the conventional femoral approach reported in recent literature. In this study, retrograde access consistently enabled successful completion of GAE without notable discrepancies in treatment efficacy or safety. This approach resulted in a high technical success rate with no significant complications. Study findings support the potential for widespread adoption of the retrograde approach for treating osteoarthritis with GAE, particularly in patients in whom an antegrade approach may pose a higher risk of complications.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100339"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world outcomes of above-knee amputation: Investigating the impact of peripheral arterial disease","authors":"Micah Thomas BS ,&nbsp;Aaron Ebeweber MS ,&nbsp;Maham Rahimi MD, PhD","doi":"10.1016/j.jvsvi.2026.100353","DOIUrl":"10.1016/j.jvsvi.2026.100353","url":null,"abstract":"<div><h3>Objective</h3><div>Above-knee amputation (AKA), or transfemoral amputation, represents a highly morbid surgical procedure, typically performed in patients with irreversible limb compromise due to peripheral arterial disease, diabetes, trauma, or malignancy. Despite prior declines, U.S. incidence of AKA has risen 4% annually since 2012, paralleling an aging population and evolving comorbid risk profiles. Given its profound functional, psychosocial, and systemic implications, a contemporary understanding of real-world outcomes is essential. This study evaluated demographic characteristics, preoperative comorbidities, and postoperative complications of patients undergoing AKA using the TriNetX global health research network, comparing large-scale patient data with published literature to identify gaps between controlled research and clinical practice.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was performed using deidentified electronic health records within TriNetX, identifying approximately 23,000 patients who underwent AKA via Current Procedural Terminology codes 27590, 27594, and 27596. Demographics, preoperative comorbidities, and postoperative outcomes—including stroke, myocardial infarction, infection, venous thromboembolism, contralateral limb amputation, and mortality—were assessed longitudinally and compared with systematically reviewed literature cohorts (n = 56-2879 patients). Statistical comparisons were conducted using two-proportion <em>z</em> tests (<em>P</em> &lt; .05).</div></div><div><h3>Results</h3><div>TriNetX patients were younger (70 vs 75 years) and more often male (61.3% vs 47.4%) than literature cohorts. Compared with literature, TriNetX showed higher rates of chronic kidney disease (39% vs 23.9%) and end-stage renal disease (16% vs 12.9%) but lower rates of smoking, stroke, congestive heart failure, and diabetes. Major postoperative complications accumulated progressively: stroke (11.6%), myocardial infarction (14.1%), deep vein thrombosis (6.6%), pulmonary embolism (6.1%), and contralateral limb amputation (54.2%) by 11 years. All-cause mortality reached 19.9% at 1 year and 34.6% at 20 years.</div></div><div><h3>Conclusions</h3><div>AKA represents a sentinel event signaling advanced systemic vascular disease and high long-term morbidity and mortality. TriNetX data reveal substantial cerebrovascular, cardiovascular, and contralateral limb complications exceeding prior reports. These findings support multidisciplinary postamputation pathways emphasizing cardiovascular risk reduction, thromboembolic prophylaxis, wound management, and proactive contralateral limb surveillance to improve survival and quality of life.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100353"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved maturation of two-stage over single-stage basilic vein transposition for first-time hemodialysis access creation: A multilevel model","authors":"Max Zhu MD,&nbsp;Joel Kruger MD,&nbsp;Joshua T. Geiger MD, MS,&nbsp;Irina Kanzafarova MD,&nbsp;Jose Aldana MD,&nbsp;Adam Doyle MD,&nbsp;Doran S. Mix MD,&nbsp;Michael C. Stoner MD,&nbsp;Karina A. Newhall MD, MS","doi":"10.1016/j.jvsvi.2025.100345","DOIUrl":"10.1016/j.jvsvi.2025.100345","url":null,"abstract":"<div><h3>Objective</h3><div>Successful brachiobasilic arteriovenous fistula (BBAVF) creation can be performed in single or two stages, with evidence supporting either approach. Although surgeon and practice pattern often influence surgical approach, little is known about the role of practice patterns in maturation and reintervention-free fistula survival.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study using the Vascular Quality Initiative from 2011 to 2022, including patients undergoing BBAVF procedures for first-time hemodialysis access with at least 4 weeks of follow-up. The primary outcome was fistula maturation. Our analysis incorporated a multilevel model, clustering by surgeon effects. Secondary analysis examined 1-year freedom from the composite outcome of access reintervention, fistula abandonment, or death, using Cox proportional hazards modeling and Kaplan-Meier survival analysis. Likelihood ratio testing was used to analyze model fit.</div></div><div><h3>Results</h3><div>Among 6417 patients, 1347 (21%) underwent single-stage and 5043 (79%) underwent two-stage BBAVF creation. Overall maturation was 60.6%. On univariable analysis, two-stage fistulas had higher maturation (62.3% vs 54.3%, <em>P</em> &lt; .001) and 1-year reintervention-free fistula survival (50.5% vs 47.9%, <em>P</em> = .008). Multilevel adjusted analysis demonstrated that two-stage procedures were associated with higher maturation rates (odds ratio: 1.4, 95% confidence interval: 1.1-1.6, <em>P</em> = .001) and lower 1-year composite reintervention, abandonment, or death risk (hazard ratio: 0.88, 95% confidence interval: 0.8-0.98, <em>P</em> = .018). Clustering by surgeon random effects significantly improved model fit for maturation rate (likelihood ratio: 66.9, <em>P</em> &lt; .001) and 1-year reintervention, abandonment, or death (likelihood ratio: 4774.7, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Two-stage BBAVF creation was associated with superior maturation and 1-year reintervention-free fistula survival, even after adjusting for surgeon practice patterns. With other patient factors equal, a two-stage approach should be considered for first-time BBAVF creation.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100345"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of physician-modified endograft utilization using online databases and social media","authors":"Rob Tatum MD ,&nbsp;Michael Nooromid MD ,&nbsp;Paul DiMuzio MD ,&nbsp;Babak Abai MD","doi":"10.1016/j.jvsvi.2025.100314","DOIUrl":"10.1016/j.jvsvi.2025.100314","url":null,"abstract":"<div><h3>Background</h3><div>To characterize the present landscape of physician-modified endograft (PMEG) use and the impact of an institution's investigational device exemption (IDE) status on endograft use by analyzing publication trends and social media coverage.</div></div><div><h3>Methods</h3><div>We used the social media platform X and three online bibliographic databases to perform a keyword search using the following terms: PMEG, physician-modified endograft, and laser fenestration. Data extracted from X and online articles included authorship, IDE protocol status, pertinent clinical outcome measures, and others. An internet search was performed to determine which institutions offered revascularization with a custom-made device within an IDE protocol and which institutions were performing PMEGs without an IDE. Data were compared using standard methods.</div></div><div><h3>Results</h3><div>Our search identified 177 X posts and 315 published articles between 2017 and 2024. We found that 61% (109/177) of X post authors were male, and the most frequently mentioned device was Cook (n = 21) followed by Gore (n = 12) and AFX (n = 2). There were 306 articles published in peer-reviewed journals, and 217 articles described at least 10 procedures. An IDE was mentioned in 3.9% of X posts (7/177). Sixty-seven percent of posts (119/177) mentioned a thoracoabdominal repair compared with 18% (32/177) mentioning arches and 15% (26/177) not indicating repair type. Of the 74 posts mentioning the number of branch grafts, 35% (26/74) were three-branch, and 65% (48/74) were four-branch repairs. Of the X posts, 64% (114/177) were related to procedural technique followed by 20% meeting presentations (34/177), 14% education (n = 24), and 2% mentorship (n = 5). The most frequently observed complication was endoleak (n = 8), followed by aneurysmal degeneration (n = 3) and stent migration (n = 1). Among published articles, most institutions were academic (n = 236) and urban (n = 209). Of the 274 articles for which author training history was available, most institutions were in the United States (n = 238) and urban (n = 211). The most frequently reported outcome was endoleak (n = 249), followed by need for reintervention (n = 199), stent migration (n = 57), and aneurysmal degeneration (n = 41). Only 31% of institutions (97/315) had an IDE; the remaining 69% (218/315) were performing PMEGs without an IDE. Of the 144 articles indicating commercial device use, Cook was the most frequently reported platform (n = 97) followed by Gore (n = 47).</div></div><div><h3>Conclusions</h3><div>PMEG has become a broadly used treatment option for patients with complex thoracoabdominal aortic disease at non-IDE centers. A less restrictive regulatory environment may expand patient access to custom-made devices without sacrificing patient safety standards. Collaboration is needed between vascular surgeons, device manufacturers, and lawmakers to achieve this goal.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100314"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of body fat quality on long-term survival following endovascular repair for abdominal aortic aneurysms","authors":"Hirotsugu Ozawa MD, PhD,&nbsp;Takao Ohki MD, PhD,&nbsp;Kota Shukuzawa MD, PhD,&nbsp;Daisuke Yamagishi MD,&nbsp;Takehiro Suzuki MD,&nbsp;Ryo Nishide MD,&nbsp;Kentaro Kasa MD,&nbsp;Makiko Omori MD,&nbsp;Soichiro Fukushima MD","doi":"10.1016/j.jvsvi.2025.100323","DOIUrl":"10.1016/j.jvsvi.2025.100323","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to evaluate the impact of body fat quality and quantity on long-term survival following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs).</div></div><div><h3>Methods</h3><div>A single-center, retrospective cohort study was performed on 237 patients who underwent primary EVAR for AAAs from 2016 to 2019. Fat quality was assessed by measuring the Hounsfield units (HUs) of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) at the level of the third lumbar vertebra on preoperative noncontrast computed tomography. Fat quantity was assessed by measuring the area (cm²) of SAT and VAT at the level of the umbilicus. Hazard ratios for all-cause mortality were calculated for each variable using univariate and multivariate analysis.</div></div><div><h3>Results</h3><div>This study included 237 patients with a mean age of 76.8 years, of whom 33 were female. The median body mass index was 23.4 kg/m² (interquartile range, 21.6-26.0 kg/m²), and 226 patients (95.3%) were classified as nonobese. During the median follow-up period of 72 months, there were 107 all-cause deaths. In univariate analysis, overall survival was significantly lower in patients with higher SAT or VAT density or larger SAT or VAT area among body fat-related parameters. In a multivariate analysis, SAT density was an independent risk factor for all-cause mortality following EVAR (SAT density: hazard ratio, 1.02; 95% confidence interval, 1.01-1.03; <em>P</em> = .007), along with other variables including age, sarcopenia, osteoporosis, and aneurysm diameter.</div></div><div><h3>Conclusions</h3><div>Patients with higher SAT density showed increased all-cause mortality following EVAR. This finding suggests that fat quality, rather than fat quantity, may be more closely associated with long-term survival in post-EVAR patients.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100323"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Office-based lab mesenteric angiography is safe for low- and moderate-risk patients","authors":"John Fang DO,&nbsp;Niteesh Sundaram MD,&nbsp;Omer Riaz MD,&nbsp;Thomas Lee MD,&nbsp;Kevin James MD","doi":"10.1016/j.jvsvi.2025.100331","DOIUrl":"10.1016/j.jvsvi.2025.100331","url":null,"abstract":"<div><h3>Objective</h3><div>There has been a significant shift of vascular care and intervention from the inpatient to the outpatient setting. The office-based laboratory (OBL) is an increasingly adopted treatment model following the 2008 payor reimbursement modifications for outpatient vascular intervention by the Centers for Medicare and Medicaid Services. Reports on this phenomenon largely focus on the financial effects, with a paucity of safety and outcomes data associated with this treatment setting. In this study, we examine treatment outcomes of elective mesenteric angiograms performed at an OBL, and factors affecting patient selection for safe outpatient intervention.</div></div><div><h3>Methods</h3><div>A retrospective study was performed of adult patients treated with diagnostic or interventional mesenteric angiography at a single OBL over 9 years. Patient and treatment variables were abstracted from outpatient and inpatient medical records. Primary outcomes of interest were 30-day adverse events (30D A/E) reported with the Clavien-Dindo (CD) classification system. Technical success was examined as a secondary outcome.</div></div><div><h3>Results</h3><div>Between September 2015 and February 2024, 80 patients underwent 115 mesenteric angiograms by seven vascular surgeons. Patients were 73 years old on average (standard deviation, 9.3 years; range, 44-89 years), predominantly female (53 of 80 patients), predominantly low risk (97 of 115 angiograms were performed on patients with Society for Vascular Surgery and the American Association for Vascular Surgery Medical Comorbidity Score &lt;2), with a mean body mass index of 25.9 kg/m² (range, 14.1-50.6 kg/m²; standard deviation, 6 kg/m²). The overall incidence of 30D A/Es was 6.1% (7 of 115), with a 5.2% 30D rate of morbidity (6 of 115), and 0.9% 30D rate of mortality (1 of 115). Six of seven cases with 30D A/Es were CD grade 3 or greater. An univariable comparison of mesenteric angiograms resulting in a 30D A/E with those without demonstrated no significant differences in mean age, race distribution, mean body mass index, preoperative Society for Vascular Surgery/American Association for Vascular Surgery Medical Comorbidity Score, smoking history, history of malignancy, use of antithrombotic medications, history of prior mesenteric stents, or whether the procedure was performed for reintervention. On multivariable regression, technical failure was a significant predictor for complications CD 3 or greater (odds ratio, 6.36; 95% confidence interval, 1.1-37.4; <em>P</em> = .04) when correcting for interoperator variability.</div></div><div><h3>Conclusions</h3><div>Variable complexity mesenteric angiography for primary and repeat intervention is safely performed at an OBL on selected low- and moderate-risk patients. Further study of anatomic and patient selection factors predicting technical failure is required.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100331"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted carotid stenting: Precision, ergonomics, and the next frontier in vascular surgery","authors":"Clark J. Zeebregts MD, PhD ,&nbsp;Emiel W.M. Huistra MD ,&nbsp;Tomas Baltrunas MD, PhD ,&nbsp;Alan B. Lumsden MD","doi":"10.1016/j.jvsvi.2025.100346","DOIUrl":"10.1016/j.jvsvi.2025.100346","url":null,"abstract":"","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100346"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}